23A-013 (3) BP-2021-2149
26 PARK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-013-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2149 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
ADAM QUENNEVILLE ROOFING &
Est. Cost: 16499 SIDING 070626
Const.Class: Exp.Date:08/21/2023
Use Group: Owner: STOWELL JETT E& SANDRA D TRUSTEES
Lot Size (sq.ft.)
Zoning: URB Applicant: ADAM QUENNEVILLE ROOFING & SIDING
Applicant Address Phone: Insurance:
1600LD LYMAN RD (413)536-5955 AWC4007012861
SOUTH HADLEY, MA 01075
ISSUED ON:11/08/2021
TO PERFORM THE FOLLOWING WORK:
ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House # Foundation:
Driveway Final: Final: Final: Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 166,44,..,
Fees Paid: $40.00
212 Main Street, Phone 413 587-1240,Fax: 413)587-1272
Office of the Building Commissioner
Department use only
-rr r City of Northampton,' ` , Status of Permit:
rso �" Building Department —.,,,, Curb Cut/Driveway Permit
212 Main S eet / Sewer/Septic Availability
�c Room 1 0 No Water/Well Availability
=.a -: Northampton, (VIA 01060 5 ),�,r Twd Sets/of Structural Plans
�' phone 413-587-1240 /Faxr41�3- 7-1272 - Plot/site/Plans
- , /:/,i/n,,, Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE.OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
26 Park St Florence Ma 01062 Map A 3A- Lot U i Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT I
2.1 Owner of Record:
Jett Stowell 26 Park St Florence Ma
Name(Print) Current Mailing Address: 413-575-8396
see contract
Telephone
Signature
2.2 Authorized Agent:
Adam Quenneville 160 Old LymanRd South Hadley Ma 01075
Name(Print) Current Mailing Address:
/ 413-536-5955
SignatA
Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 16,499.00 (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee 41_0
4. Mechanical (HVAC)
5. Fire Protection
6. Total= (1 +2+3+4+5) 16,499.00 Check Number I I t 017
'L nd This Section For Official Use Only
Building Permit Number: [�/� — /' � Issued:
/61? Date
Signature: k/
7F__. 1 I- 8-z0Z 1
Building Commissioner/Inspector of Buildings Date
operations.aqrs @ gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW x YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW x YE�
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW x YES
IF YES has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES NO IX
IF YES, describe size, type and location:
E. Will the construction activity disturb clearing, gradin excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YE II NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing LA
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [0 Siding [El] Other[M]
Brief Description of Proposed New roof, remove&replace existing, install new drip edge, ridge vent, ice&water barrier, pipe boot flashing
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Jett Stowell
I, , as Owner of the subject
property
Adam Quenneville
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
see contract 11/1/2021
Signature of Owner Date
I, Adam Quenneville , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Adam Quenneville
Print Name /
v 11/1/2021
Signature of Owner/Agent Date
ON 8-CONSTRUCTION SERVICES
sensed Construction Supervisor: Not Applicable 0
)f License Holder: Adam Quennville CS-070626
License Number
Did Lyman Rd South Hadley Ma 01075 8/21/2023
s � Expiration Date
413-536-5955
ire Telephone
iistered Home Improvement Contractor: Not Applicable 0
am Quenneville Roofing &Siding Inc 191093
any Name Registration Number
Old Ly an Rd South Hadley Ma 01075 3/22/2022
ss Expiration Date
Telephone 413-536-5955
ON 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Ts Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
denial of the issuance of the building permit.
i Affidavit Attached Yes X No ❑
City of Northampton
Massachusetts
/ i f -
;\ f fi1r" DEPARTMENT OF BUILDING INSPECTIONS
�� .. r,.. � �
} ;`oc
212 Main Street •Municipal Building
,-, Northampton, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
26 Park St Florence Ma
(Please print house number and street name)
Is to be disposed of at:
Adam Quenneville Roofing&Siding 160 Old Lyman RD South Hadley Ma
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
Adam Quenneville Roofing & Siding 160 Old Lyman Rd South Hadley Ma
(Company Name and Address)
n
i-\•--/ I k\03\)--\
Signature Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
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•MA 01075
-
160 Old Lyman Road•South Hadley20 Q winner;
asig
1.800.NEW.ROOF • 413.536.5955 We are Licensed
Fully Insured
Email:inio01800newrooF.net Website:www.1800newroof.net Factory Trained
MA Construction Supervisors Lic.#070626 MA Registration#120982
Factory Certified Installers
Member of the Home Builder's Assoc,of Western Mass. CT Registration#575920
Member of the Building&Trade Association
P.P.0 38710
Proposal Submitted To: Date: Phone Ifs: C:l�/�,S7-r o.3]� ,
Jett Stowell 10/13/2021 H:
W:
Street: Email:
26 Park St.
City,State,Zip Code: Special Requirements:
Florence, MA 01062
PROPOSAL FOR:
HOUSE GARAGE OTHER
RECOVER
Layers: 0 2 3 4 Plywood Included: Yes o No
0 Tear off SLATE or SHAKES
COMPLETE ROOF PROTECTIONSYSTEM:
8 We shall acquire appropriate permits for all work
El Home exterior and landscaping to be protected
8 Strip existing roofing to existing decking with full inspection DO NOT DO: porch and skylight slope
2 All project waste shall be removed by dumpster(dumpster for contractor use only)
2 Install Ice&Water Barrier at all eaves 3'°6' valleys,chimneys,pipes and skylights
fa Install(1SIb.felt, underlayment over remaining decking area
2 Install Metal drip edge at eaves and rakes a5")ealn brown)
2 Install manufacturer's starter shingle on all eaves and rake edges
® Install new pipe boot flashing/vent accessories
2 Install ridge vent-Snow Country/Cobra rolled/4'Baffled Roll
Shingles:(standard 6 nails per shingle)
GAF Timberline HDZ Shingles Color: Weatherwood
GAF Timberline HDZ Ridge cap shingles
Warranty Options:
N We guarantee our workmanship for 10 full years
❑ GAF System Plus Warranty
❑ GAF Golden Pledge Warranty
Chimney Options:
❑ Lead Counter Flashing 0 Water Seal&Tuckpoint ❑Rubberized Crown ❑Cricket
0 Mason needed(customer provided)
Additional material and labor charges may apply.
8 Deteriorated existing decking will be replaced at$5.99 per sq. and dimensional lumber at$7.00 per linear ft.,
after full inspection. Customer Initials:
16,499.00
We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of: Total Due:($ 5,499.00
ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are
Down Payment:($ )
satisfactory and are hereby accepted.You are authorized to do work as specified. 2 d Payment at Start Job:($ 5,500.00 )
Balance Due Upon Completion:($ 5,500.00 )
Payment will be 1/3 down at signing,1/3 at start of job,and balance due
upon completiop.
Date: ife 4rP�/ Signature:
Date: 10/13I2021 Estimator:(Print Name)S. M{Yife(Br (Sign Name)aitAi Nan
ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the
possibility of roofing debris or dust coming in through cracks of the wood.Adam Quenn oofing will not be
responsible for debris or dust in the attic or storage areas. Customer Initials:
® DATE(MMIDOIYYYYI
r „ 1 ACORD CERTIFICATE OF LIABILITY INSURANCE
6/24/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER -CDNTAi.T Sarah Promo
.NAME
Clayton Insurance Agency, Inc. PHONE (413)536-0804
0.1 sl%
ulnssa-7e74
INC,No.@rt4 1649 Northampton Street L Ess,epremoQalaytoninsurance.net
B. O. Box 989 INSURERS'.AFFORDING COVERAGE NAIC r
Holyoke MA 01041-0989 INSURERA:Nautilus Insurance Company
INSURED INSURER Et:Arbella Insurance Co. ,
Adam Quenneville Roofing 6 Siding Ina. ,INSURER.C:AIM Mutual Insurance Company
160 Old Lyman Road INSURER D
South Hadley, MA 01075 INSURER E:
INSURER F: --
COVERAGES CERTIFICATE NUMBER:2021 MASTER REVISION-NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED NOTWITHSTANDING ANYREQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS ANL)CONDITIONS OF SUCH POLICIES.UNIITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I
INSR TYPE Of INSURANCE 'ADOL7UBRr POLICY EFF POLICY EXP LIMITS
L Tt ,INFn1 Vifyrf., POLICY NUMBER IMMR)OfVYYYI EMMIO0(VYVYI
x COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE S 1,000,000
� DAMAGE TORENSE(S g 100,000
A : CLAIMS.MAOE l i OCCUR PREMISES tEa 04Amgnc*t
NN7.263313 6/23/2021 - 6/23/2022 MED EXP(Any one person) S 5,000
PERSONAL d ACV INJURY S 1,000,000
GEML AGGREGATE LIMITAPPLIESPER: GENERALAGOREGATE S 2,000,000
77--y�C {{tt POLICY n PRO• n 2,000,000
4ECT LOC PRODUCTS-COMP/OP AGG S
OTHER: j S
AUTOMOBILE LIABILITY - COM9INED SINGLE LIMIT j 1,000,000
(Ea grOdyl1
B ANY AUTO �— BODILY INJURY(Per person) S
AU..OWNED X SCHEDULED 1020107095 6/23/202 L 6/23/2022 BODILY INJURY(Per accident) S
AUTOS AUTOS
NON•ONNNED PROPERTY DAMAGE i
X HIRED X AUTOS IP.r eDOOff60I
IJNIN0NNOERINS MOTORISTS S 100,000/300,000
X UMBRELLA LIES OCCUR EACH OCCURRENCE ,S 5,000,000
—
A EXCESS LIAR _� CLAIMS-MADE AGGREGATE S 5,000,000
DED RETENTION$ AN1242102 6/23/2021 6/23/2022 S
WORKERS COMPENSATION X SE (UTE _ ER
AND EMPLOYERS'UABILITY Y/N - -
ANY PRCPRIETORIPARTNERJEXECUTIVE E.L.EACH ACCIDENT 4 1,000,000
OFFICER/MEMBER EXCLUDED? n N f A
C (Mandatory in NH) .AWC4007012861 4/29/2021 4/29/2022 EL.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below EL,DISEASE-POUCY LIMIT S 1.000,OQO
DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additions,Remarks 3ahedule,may be attached It mars.pane Ia required)
Tor In.fos'mational Purposes Only
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
Adam Quenneville Roofing i4 Siding Inc THE EXPIRATION DATE THEREOF,NOTICE WILL SE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
160 Old Lyman Rd
South Hadley, MA. 01075
AUTHORIZED REPRESENTATIVE
Michael Regan/L•'HT 44,/ 4I"`
1
Q 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS023(2D1401)
• r
Department of Industrial Accidents
MOW•OF
Office of Investigations
1.
600 Washington Street
—= ; Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /� Please Printnt Legibly
Name(Business/Organization/Individual): A &w, G en•swt 1tt- Qcio�tet(s- t�' Yt� �'j i+tY i'j(—
Address: ILO 01 c L vM. „, (-L
City/State/Zip: 50U \ ekAkta (11►o 016)5 Phone#: Lf 13 —53C 5955—
Are you an employer?Check the appropriate box: Type of project(required):
I.�[tam a employer with 15 4• ❑ I am a general contractor and I 6_ (2 New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers'comp. insurance comp. insurance.t 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions
m self. [No workers'comp. right of exemption per MGL
y12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
"Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: A i'01 v E veAA
Policy#or Self-ins. Lic. #: A w C fool 0 1 aTC I Expiration Date: Vacila
Job Site Address: City/State/Zip:t lorPttce Mil 0lO( )
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: / Date: I Io3lc�-1
Phone#: L 13 ` 5 3L - 5 15 7
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
' • \''''' Board of Building Regulations and Stanaaras
Co nsgtltttlil.YYsllprvisor
61
CS-070626f"K'',>
�' „ �s spires:08/21/2023
ADAM A OWN NEV i.4` t'•"'.. y. -
,160 OLD LYMAN olli tf� ` � ;
' SOUTH HADL ,Y • r: • *'' ' r
A _; 0, .' "! t 'fit s_
'• l..4 Y
Commissioner dait K. YErn liuk_.
Q Wo4rivino/rbazeald QlgiitzaSaG rieede (,%S
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710 •
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
Registration: 191093
ADAM QUENNEVILLE ROOFING AND SIDING,INC. Expiration: 03/22/2022
180 OLD LYMAN RD.
SO.HADLEY,MA 01075
Update Address and Return Card.
SCA I 0 20M-05117
P.: °i 1-f 1.! ifs_ 't�' !t� P iLy �i� �!__1i4 °tw_ � _ "Lit' *� "�fr �fr_ !ttt :!U!�"_ "�1t_
STATE
OF CONYNECTICU'T + DEPARTMENT OP CO[S S"UMER PROTECTION ,
:Be.it known that '�,,;
i <'
A . ADAM QU,ENNEVILLE . .;
i•
160 OLD LYMAN ROAD ' I°
K. SOUTH HADLEY, MA 01075-2632
H
P' has satisfied the qualifications requited by law and is hereby registered as a
' i HOME: IMPROVEMENT'CONTRACTOR ',--
r<< i Registration # HIC.0575920
I
i %'
D;:_ ADAM QUENNLVILLE ROOFINGj � z
i `
ll Effective: 12/01/2020 '-�'
' , Expiration: 11/30/2021411Z. . , �,•\^,.
Michelle Seagull.Commissioner i,